Autism spectrum disorder (ASD): Screening and diagnosis

Autism screening

Your pediatrician will complete an autism screen for your child at their 18-month and 24-month well-visit appointment. The autism screen can help identify early signs of behavioral and developmental differences to help diagnose autism spectrum disorder (ASD).

Screening tools

There is no single standardized tool for autism screening. Most pediatricians use the Modified Checklist for Autism in Toddlers (M-CHAT-R/F), which includes a 23-point questionnaire completed by parents. This screening tool helps identify language delays, behavioral concerns, and developmental differences.

Signs of autism in babies and toddlers:

• Emotional: Limited emotional expression and difficulty understanding emotions.
• Social: Poor eye contact, limited use of gestures, and difficulty in engaging in social interactions.
• Developmental: Delayed speech and language skills, does not engage in pretend play, and delayed motor skills.
• Behaviors: Repetitive movements (hand-flapping, rocking), restricted interests, and extreme resistance to changes in routine.
• Sensory sensitivities: Aversion to loud noises and certain textures.

Signs of autism in older children:

• Emotional: Difficulty understanding and expressing emotions, high anxiety, and mood swings.
• Social: Difficulty making friends and understanding social cues and preference for solitary activities.
• Developmental: Persistent language difficulties, challenges in academic performance, and motor coordination issues.
• Behaviors: Repetitive behaviors, intense focus on specific interests, and difficulty adapting to changes.

Diagnosing autism spectrum disorder

Screening for autism is different from diagnosing it. If your child has a positive autism screening, your pediatrician may recommend further testing for a formal diagnosis. However, even if your child does not screen positive but exhibits symptoms or developmental difficulties, discuss additional testing with your pediatrician. Screening tools are not definitive, and their rate of success for identifying autistic children is not 100% accurate.

Autism is diagnosed through a comprehensive evaluation by a multidisciplinary team, using standardized tools such as the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R). The diagnostic process typically includes:

• Clinical observation: Watching how the child interacts, plays, and communicates in a clinical setting.
• Parent interviews: Gathering developmental history and behavioral patterns from parents.
• Medical and genetic testing: Conducting tests to rule out other conditions that may present similar symptoms, like developmental disorders.
• Detailed history and physical examination: To assess for developmental delays or issues.

When to consult a pediatrician:

Consult your pediatrician if you have concerns about your child's development or notice concerning symptoms like poor eye contact, delayed speech, or repetitive behaviors. Early consultation is important for timely diagnosis and intervention.

If you have questions about autism spectrum disorder (ASD), reach out to your local or Summer Health pediatrician for support. Summer Health is a pediatric telehealth platform offering 24/7 care, providing answers for everything from urgent concerns to everyday questions about your child’s health.

References

AAP: How Pediatricians Screen for Autism